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Fact Sheets:
A Normal Reaction to an Abnormal Situation
All of these feelings and reactions are normal and natural even though
they may seem unusual and even though some are very different from
others. We are all individuals. We all respond in our own unique way.
The incident cannot be erased. The memory will always be a part of your
life. Everyone moves at their own pace through the stages of crisis and
healing. Everyone has their own clock. For some people, there may be
ongoing problems.
Possible Reactions:
| Anger |
Grief |
| Flashbacks |
Guilt |
| Crying |
Despair |
| Fatigue |
Depression |
| Confusion |
Numbness |
| Sleep disturbances |
Loss of trust |
| Feeling overwhelmed |
Anniversary difficulties |
| Change in appetite/weight |
Alcohol/drug abuse |
| Feeling inadequate |
Excessive use of sick leave |
| Low resistance to illness |
Work/school/family problems |
| Frustration |
Outrage |
| Regression |
Insecurity |
| Concentration problems |
Fear |
| Helplessness |
Suicidal thoughts |
| Memory problems |
Anxiety |
| Irritability |
Withdrawal |
| Difficulty returning to normal activity level |
Religious confusion |
| Self-doubt |
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What To Expect As Recovery Continues
- Survivors of trauma may experience periods when they alternate
between anxiety and re-experiencing the incident and times when they
are depressed and withdraw from family, friends, and important
activities. The changes are normal and to be expected.
- Situations which strongly remind the survivor of the incident,
will induce PTSD symptoms. These might include reading certain
articles in the newspaper, being in the area where the incident
occurred, or being asked to retell the story.
- It is not uncommon for hearings, trials, and other meetings
related to the incident to increase post-trauma consequences.
- Anniversaries of the event (one week, one month, one year, 10
years) may bring memories back and increase post-trauma
consequences.
- Families and friends become co-survivors and often experience
post-trauma consequences.
- Survivors should not expect that their life will return to
"normal." Rather, a successful recovery means managing post-trauma
symptoms and finding a "new normal."
Post-Trauma Debriefing:
Suggested Post-Trauma "Do's and Don'ts"
Depending on the post-trauma incident and consequences, these are
examples of coping skills for debriefing participants.
| DON'T |
DO |
| Drink alcohol excessively. |
Get ample rest. |
| Use legal or illegal substances to numb consequences. |
Normalize post-trauma consequences. |
| Withdraw from significant others. |
Take time for leisure activities. |
| Use legal or illegal substances to numb consequences. |
Normalize post-trauma consequences. |
| Stay away from work. |
Find and talk to supportive peers and/or family members about the incident. |
| Have unrealistic expectations for recovery. |
Maintain a good diet and exercise. |
| Look for easy answers. |
Learn about post-traumatic stress disorder. |
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Spend time with family and friends. |
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Expect the incident to bother you. |
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Get extra help from a post-trauma counseling center if you need it. |
What To Do About Flashbacks?
- REMEMBER! Flashbacks are normal after a critical
incident. You are likely to experience more flashbacks if you believe
that you are "going crazy" or "losing it." Flashbacks will likely fade
as you remind yourself that they are okay.
- Flashbacks may follow a "trigger." A trigger is an event or thought
which reminds you of the traumatic incident. It is also possible that
there will be no trigger. These flashbacks seem more scary because
they are less easily explained.
- Learn how to talk to yourself. When you have a flashback, remind
yourself of the facts. Talk to yourself by saying something like:
"I'm okay. I just had a really scary flashback.
Flashbacks are normal after the incident I lived
through. I will be okay in a minute or so."
- Learn how to talk to others. Use your support systems. Go to a
peer supporter or a friend who can listen to you. Tell them in detail
about what you have experienced. Ask them if you can talk to them
again when you have other Post-Traumatic Stress feelings.
- If flashbacks interfere with your work or at home, consider
seeking post-trauma counseling from a qualified, experienced
professional.
Skill Building For Survivors
| Survival Rule |
Post-Trauma Consequences |
Skill Building Techniques |
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| Be Alert |
Hyperalertness
Flashbacks
Sleep Disorder |
Relaxation Skills
Self-Talk Skills
Normalization |
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| Be Strong |
Numbing
Relationship Problems
Angry Outbursts |
Assertion
Communication Skills
Cognitive Management
Ventilation |
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| Don't Think |
Numbing
Physical Symptoms
Sleep Disorder
Anniversary Responses
(Severe) |
Ventilation
Logs/Modification
Stress Management
Normalization |
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| Act OK |
Relationship Problems
Intrusive Thoughts |
Couple Counseling
Ventilation
Cognitive Management |
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| Talk About It |
Reduces PTSD Feelings |
Reinforce
Illustrate Benefits |
Coping With Bereavement
The loss of someone close, especially as a casualty during deployment
or war, is one of life's most stressful events. It can leave you so
numb that you have difficulty recognizing the reality of death or
coping with its impact on your life.
Even so, you're forced to deal with ideas that cause a great deal of
pain. We know, for example, that a refusal to acknowledge "the facts
of death" is a disservice to the dying and the living alike, but doing
so forces the acknowledgment of how real this situation is, and it
hurts.
This fact sheet was not created to make the pain go away--unfortunately,
nothing can do that for you--but to help you understand the intense
emotions you're experiencing or are going to soon feel.
Background
Bereavement literally means "being deprived by death." It describes a
process all people go through when someone close dies. Each person
experiences this process differently, but there are some characteristics
common to most instances of bereavement:
It doesn't progress in an orderly fashion.
You probably won't find yourself moving systematically from one
well-defined stage to another. Instead, you'll probably drift back
and forth from what might best be described as overlapping, fluid phases
of anger, denial and acceptance.
It involves emotions and behavior that wouldn't be described as normal under other circumstances.
While some people benefit from professional help to cope with their
grief, you shouldn't automatically interpret emotions or acts as a sign
that you're losing your sanity.
It's frequently complicated.
The initial numbness makes the later physical and emotional upheaval
all the more frightening, or seem a sign of weakness but it is not.
Grieving is a healthy, necessary process, and refusing to grieve may
postpone inevitable reactions that build up into later crises.
By design, bereavement is self-centered.
You need all your energy to cope with your emotions. Resist the
inclination to put your own needs aside in an effort to meet those
of your family; a healthier idea would be to secure outside support
and guidance from a mental health professional.
The Experience Of Normal Grief
Feelings - sadness, anger, guilt, anxiety, loneliness, helplessness,
hopelessness, shock, yearning, relief, and numbness.
Physical Sensations - hollowness in stomach, tightness
in the chest, tightness in the throat, oversensitivity to noise, a sense
of depersonalization, feeling short of breath, weakness in the muscles,
lack of energy, dry mouth, and fatigue.
Cognitions - disbelief, confusion, preoccupation, sense
of presence, hallucinations, and dreams about the deceased.
Behavior - sleep disturbance, appetite disturbance,
social withdrawal, absent-minded behavior, avoiding or seeking out
reminders of the deceased, sighing, restlessness, crying, and visiting
places or carrying objects that remind the survivor of the deceased.
Phases:
- Numbness
- Yearning
- Disorganization and Despair
- Reorganized Behavior
What Helps?
Effective coping with bereavement really depends on your ability to
mourn properly. When a loved one dies, there are many things which
will help you cope better with the pain. Some examples include:
People who care:
Family, friends, neighbors, colleagues, and strangers in a mutual support
group who have "been there" can all offer support. A lifetime habit of
close, caring relationships is the best possible preparation for
bereavement.
Understand the "facts of death."
This is a particularly important in time of war. Knowing what to expect
and knowing your options helps. Express your feelings--talk, be angry,
weep. You are not alone; all grieving people need such outlets.
Reach out for help.
Others cannot always make the first move. They may be afraid of
intruding on your privacy. Make your needs known. Seeking out a
mutual support group in your community is a great first step.
Keep in touch with your physician.
Following your physician's advice can help you deal with physical side
effects.
Accept the inevitable.
Some things in life, and certainly in war, have no basis in logic; they
just happen. Accepting this can prevent much bitterness and self-blame.
Don't rush into major life changes.
Moving, changing jobs, or remarrying are too important to rush. This is
no time to make major decisions. Your judgement may be poor and the
changes are only likely to add to your stress. Wait a year. Make big
decisions then. Introduce new relationships gradually and carefully--let
them grow.
If you find yourself in need of more assistance than friends and family
can provide, contact your clergyperson or your physician. Your local
Mental Health Association can also help you find the support you need.
How To Help Those You Care About
- Understand that emotional consequences follow a traumatic
experience.
- Don't expect that the person you care about will "get better" in a
certain amount or time or in a certain way. Sometimes recovery is a
long and difficult process. If the person requires more time than you
expected, you may feel frustrated or even angry.
- Tell the survivor how you feel: that you are sorry they have been
hurt.
- Encourage the survivor to talk to you about how they feel. When
they do, listen without interrupting or making judgements about what
you hear. All survivor's feelings are ok even if you might not feel
the same way.
- Remind the survivor that their confusing emotions
are normal.
- DO NOT attempt to impose your explanation
on why this has happened to the survivor. It probably won't be the
explanation the survivor believes and imposing your view might hurt
your relationship with them.
- DO NOT tell the survivor, "I know how you
feel" or "Everything will be all right." Often, these statements are
really efforts to relieve your own anxiety about how you feel about
what has happened to the survivor. Survivors say that when they hear
these statements they thing that people do not care about or understand
them.
- Go to any court hearings, community meetings or other appointments
that relate to the trauma. This is an important way to provide support
to the survivor.
- Be willing to say nothing. Just being there is often all that you
can do to help.
- Don't be afraid to encourage a survivor to ask for help in the form
of post-trauma counseling. You might even go to the first appointment
to show your support and concern.
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